Complications Following Gender-Affirming Phalloplasty: A NSQIP Review

Abstract

Background: Gender-affirming phalloplasty has a complication rate as high as 76.5%. This is the first study to determine the predictors of 30-day complications following phalloplasty using a national registry. Methods: The NSQIP database (2012-2021) was queried for transgender men and current procedural terminology codes pertaining to flap or microsurgery procedures to select for single and first stage phalloplasty cases. Included were patients with a total hospital stay ≥5 days and operating time >4 hours to select for primary phalloplasty cases. The primary outcome was incidence of major and minor complications, and the secondary outcome was indication for unplanned reoperation. Bivariate analysis and multivariate logistic regression were performed to determine significant predictors of complications. Results: Of 90 patients, n=18 (20.0%) developed at least one complication. The most common complication was unplanned reoperation (n=10, 11.1%) due to hematoma evacuation (n=3, 30.0% of reoperations, 3.3% of all patients). A total of n=43 (47.8%) underwent single stage phalloplasty, and n=47 (52.2%) underwent first stage phalloplasty. Compared to patients without complications, those with minor complications more likely to have had single stage phalloplasty (n=37 [45.1%], n=6 [75.0%]; P=0.145), but the association was not statistically significant. Longer operating time was associated with greater odds of major complications (adjusted odds ratio [aOR] 95% confidence interval [CI] 1.01 [1.002-1.018]). Patients who smoked within 1 year of surgery had 123 times the odds of 30-day minor complications (surgical site infection, urinary tract infection, wound dehiscence, pneumonia) compared to non-smokers (aOR [CI] 123.3 [1.4->100.0]). Conclusion: There were no significant differences.